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When we get stronger we're more capable of exploring our fears
The irony of human existence is that we are the highest forms of life on earth and yet ineffably sad because we are the only ones who know that we are going to die (Delillo, 1985).
My clients are often surprised when their progress in terms of health and functioning is accompanied by more frequent thoughts of death. One client in particular, who has started facing up to her own profound sense of self-doubt and who has stopped self-medicating almost nightly with marijuana or alcohol, has had moments she describes as full of "existential terror." To me, this supports my perception that she's doing much better, and is more able to let in more challenging forms of self-awareness.

Recent research has tried to explain why people who suffer from low self-esteem or are struggling in general are better at distracting themselves from thinking about the fact that they will one day die. Psychologists Wisman, Heflick, and Goldenberg have posited the "existential escape hypothesis," which says that people with lower self-esteem will be better at ignoring or deflecting reminders of their own death (Wisman, Heflick & Goldenberg, 2015).

The researchers conducted five studies on the topic. In the the first four, when people with low self-esteem were reminded of their own mortality, they exhibited a dip in self-awareness or a tendency to focus more on others rather than themselves. In the fifth study, subjects were asked to write about their own death, and then given the opportunity to drink alcohol. Those with lower self-esteem were much more likely to consume excessive amounts of alcohol than those with high or moderate self-esteem (Wisman et al, 2015).

Why are these findings interesting? To me, it's because they help cast healthy and poor functioning in a new light. It's not simply that poor functioning is characterized by distress and healthy functioning is characterized by "happiness."

In fact, a healthier person can often experience more subjective distress (e.g. when thinking about their own death) because they can tolerate a wider and deeper range of emotion.

When psychologist Abraham Maslow wrote of self-actualization, and the self-actualized person, he had this kind of sensitivity in mind. Self-actualizers may actually experience more frustration, more ambiguity, and greater discrepancies between reality and their ideals (Maslow, Motivation and Personality, 155).

Maslow described a high-functioning existence as precious and vulnerable.

He wrote,
"One very important aspect of the post mortem life [meaning, a life with an awareness of mortality] is that everything gets doubly precious, gets piercingly important. You get stabbed by things, by flowers and by babies and by beautiful things—just the very act of living, of walking and breathing and eating and having friends and chatting (Maslow, 1973)."
A person plagued by low self-esteem would have less access to both the preciousness and the vulnerability. Stronger selves aren't necessarily happier or more distracted selves. They're often doing the hard work of being self-aware, ever mindful of the threats and limits of existence.

As the novelist Don Delillo wrote in White Noise,
"Isn't death the boundary we need? Doesn't it give a precious texture to life, a sense of definition? You have to ask yourself whether anything you do in this life would have beauty and meaning without the knowledge you carry of a final line, a border or limit." (DeLillo, 1985)
References

DeLillo, D. (1985). White Noise, New York: Viking.

Maslow, A. (1954). Motivation and Personality, New York: Harper & Row.

Maslow, A. (1973). "1970" in Abraham H. Maslow: A Memorial Volume, ed. B. G. Maslow, Monterey, CA: Thomson Brooks/Cole.

Wisman, A., Heflick, N, & Goldenberg, J. L. (2015). The great escape: The role of self-esteem and self-related cognition in terror management, Journal of Experimental Social Psychology, vol 60, September, 121-132.